With staff collapsing, we need to address the NHS climate emergency
The reports emerging from NHS hospitals during this summer’s extreme heat should concern everyone involved in the future of our health service.
The Royal College of Nursing (RCN) says nursing staff are collapsing on shift, suffering dizziness and nausea and working in hospital wards and other healthcare facilities regularly exceeding 30°C. Some staff report working without functioning air conditioning, adequate ventilation or even windows that open.
This is clearly a workforce and patient safety issue. But it is also an infrastructure issue.
Britain cannot expect a 21st-century health service to operate effectively from buildings which were not designed for the climate conditions they increasingly have to withstand.
The RCN is calling for an urgent programme to heat-proof health facilities, including changes to NHS capital guidance so that climate adaptation is explicitly taken into account. It points to measures including better ventilation and air conditioning.
AIIP strongly supports the principle behind that call.
But we also need to answer the next question: how are we going to pay for and deliver these improvements quickly?
Climate resilience should become an NHS capital priority
Extreme heat is no longer an occasional problem that hospitals can simply work around. The consequences go beyond comfort. Hot buildings can affect staff wellbeing, patient recovery, medicines, equipment and ultimately the resilience of clinical services.
At the same time, the NHS is dealing with a huge maintenance backlog and decades of insufficient capital investment. As AIIP has previously highlighted, analysis of international health systems suggests the UK invests around half as much as comparable countries in buildings, equipment and technology.
We therefore need to stop treating maintenance, modernisation, Net Zero and climate adaptation as separate challenges.
They are increasingly the same infrastructure challenge.
When a hospital is upgraded, we should be asking whether we can simultaneously improve its ventilation and cooling, reduce its energy consumption, modernise its heating systems, install renewable energy and storage, improve insulation and make the building more resilient to future extremes of temperature.
An NHS Rapid Upgrade Programme
Last month, AIIP chair and former Health Minister Lord Hutton's published a proposal for an NHS Rapid Upgrade Programme, using carefully structured extensions to existing NHS PFI contracts to unlock private capital for hospital modernisation.
AIIP analysis suggests that extending contracts across 151 NHS PFI projects due to expire during this Parliament could potentially unlock around £15.4–£16 billion of investment.
That investment could support new clinical capacity and tackle maintenance problems. But the events of this summer demonstrate why climate resilience should also be at the heart of the programme.
An NHS Rapid Upgrade Programme could support investment in:
modern cooling and ventilation systems;
building management technology to better manage extreme temperatures;
energy-efficiency improvements and insulation;
low-carbon heating and cooling;
renewable energy generation and storage;
upgrades to electrical infrastructure needed to support modern cooling and medical equipment; and
wider adaptations that make hospitals and health centres more resilient to a changing climate.
Done properly, this would not mean choosing between Net Zero and climate adaptation.
Modernising the NHS estate provides an opportunity to deliver both.
More efficient buildings and modern energy systems can reduce emissions and operating costs while making hospitals safer and more resilient during extreme weather.
We don't have to wait for entirely new hospitals
There is understandably enormous attention on the New Hospital Programme. Britain needs new hospitals. And we believe PPP could speed up that programme.
But replacing the NHS estate could take decades under non-PPP plans.
Staff working through extreme temperatures this summer cannot wait decades.
As Lord Hutton argued when launching the Rapid Upgrade proposal:
“Sometimes the fastest way to create new capacity is not to start again. It is to build intelligently on what already exists.”
That principle applies just as strongly to climate resilience.
There are hospitals across the country where long-term investors already have relationships, contracts and detailed knowledge of the buildings involved. Government should explore how those partnerships can be used to finance and deliver upgrades now rather than waiting for existing contracts to expire before starting again.
The RCN has called the experiences of nurses this summer a “wake-up call”.
It should be one for infrastructure policy too.
The NHS needs a long-term programme to ensure its buildings can withstand the climate of the coming decades.
Government should work with NHS leaders, clinicians and long-term infrastructure investors to develop an NHS Rapid Upgrade Programme with climate resilience and Net Zero at its core.
Nurses should not be fainting because the buildings in which they work cannot cope with a British summer.
We have the technology to fix that. We have investors willing to finance modernisation.
What we need now is a mechanism to get it done.